While there is a wide recognition that diagnostic infrared imaging is a physiologic process, there is not an equally wide understanding of the underlying physiologic principles. Over fifty years ago, Lawson developed an empirical relationship linking unusually hot skin patterns with underlying cancer in the female breast and with that link founded the modern era of medical thermography (1). The basis for the elevated skin temperatures and breast cancer were the subject of considerable speculation and, as often occurs, the observations preceded the understanding. Interested individuals as well as serious investigators have speculated the heat of focal inflammation, an immune response or the inefficiencies of cancer’s metabolism as the basis for the hot patterns proximal to breast cancer (2, 3). A simple calculation of the energy requirements to maintain the increased temperatures commonly encountered with breast cancer effectively eliminated locally-generated metabolic heat as a possible mechanism for the hot patterns related to breast cancer (4).
Folkman formalized a theory of neo-angiogenesis (the development of new blood vessels) as a requirement for any malignant tumor to grow larger than 0.15mm in diameter (5). Konerding and Steinberg published a study of the ultra-structure of cancer’s neo-angiogenic blood vessels that described their structural and functional abnormalities as to exclude any effective modulation by the autonomic nervous system (6). In the past twenty years, medical scientists have discovered the very high concentrations of Nitric Oxide (a readily diffusible gas) produced by pre-cancerous and cancerous cells. Among its properties is a profound dilatory effect on regional blood vessels. These two abnormal mechanisms, structurally defective neo-angiogenic blood vessels and the strong dilatory effect of Nitric Oxide are almost certainly the basis for the high thermal energy patterns associated with cancer in the female breast as the dis-regulated hyperemia of core body-temperature blood flows to a relatively superficial area in the female breast (7, 8, 9).
The adult female breasts will present a variety of high thermal energy patterns based upon many vascular and metabolic conditions unrelated to cancer or any other pathology, such as typically occurs in the later third of the menstrual cycle, during pregnancy or lactation. On prima facie, these non-cancerous high thermal energy patterns can emulate the “hot spots” empirically associated with breast cancer with the important exception of the specific patho-physiologic dis-regulated hyperemia of core body-temperature blood associated with cancer. A simple (as in single variant) functional challenge is necessary to distinguish the hot patterns of breast cancer from the hot patterns of non-cancerous conditions with good reliability (10). The acclimation of a patient in a very cold room (17C) will dissipate latent heat of the skin but not effectively distinguish the hot patterns associated with breast cancer by temperature levels alone.
While the use of vaso-active drugs or the administration of pure oxygen have the potential to provide a single variant physiologic challenge capable of distinguishing the dis-regulated blood flow in the female breasts associated with cancer; cooling a patient’s hands by immersing them wrist-deep into a temperature-defined water bath for a specified time-span provides that consistent and simple physiologic challenge, provided the analytic parameters are derived from a substantive database. Therma-Scan developed that database from trials involving the detailed quantitative analysis of thousands of patient studies and different temperatures of the water bath and time-spans. A large-scale clinical outcome study was presented at the 2004 Congress of the American Academy of Thermology that documented the significant contribution of the cold-challenge technique for substantially increasing the diagnostic specificity of breast thermology (10). A review of the cold-challenge protocols utilized by some thermographers reveals a significant variance in technique with poor application of physiologic principles, such as allowing five to ten minutes to elapse between the cold challenge and subsequent imaging and no specified temperature of the water bath (11).
1. Lawson R. Canad Med Assn J. Implications of surface temperatures in the diagnosis of breast cancer. 1956;75:309- 310.
2. Lawson RN: Thermography-A new tool in the investigation of breast cancer. Can Serv Med J.1957;13:517-518.
3. Head J.F., Elliott R.L. Thermography. Its relation to pathologic characteristics, vascularity, proliferation rate, and survival of patients with invasive ductal carcinoma of the breast. Cancer 1997;79:186188.
4. Anbar M. Hyperthermia of the cancerous breast: analysis of mechanism. Cancer Letters, 1994.
5. Folkman, J. Tumor Angiogenesis: Therapeutic Implications. N Engl J Med. 1971;285(21):1182-1186.
6. Konerding MA & Steinberg F. Computerized infrared thermographic and ultrastructure studies of xenotransplanted human tumors on nude mice. Thermology 1988;3:7-14.
7. Loibl, S. Buck A, Strank C et al. The role of early expression of inducible nitric oxide synthase in human breast cancer. European Journal of Cancer (1990)Y. 2005;41(2):265-271.
8. Thornsen LL, Miles DW, Happerfield L, Bobrow LG, Knowles RG, Moncada S. Nitric oxide synthese activity in human breast cancer. Br J Cancer. 1995(July);72(1):41-44.
9. Martin JHJ, Begum S, Alalami O, Harrison A, Scott KWM. Endothelial nitric oxide synthase: correlation with histologic grade, lymph node status and estrogen receptor expression in human breast cancer. Tumor Biol. 2000;21:90-97.
10. Hoekstra P, The autonomic challenge and analytic breast thermology. Thermology International, 2004(14);3:106.
11. Amalu W.C. (Sept 2004) Nondestructive testing of the human breast: the validity of dynamic stress testing in medical infrared breast imaging. In Engineering in Medicine and Biology Society. pp 1174-1177
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